Many patients with mobility issues have a limited ability to change positions. These individuals are at an increased risk of developing pressure ulcers, also called pressure sores or bedsores. These patients are often confined to a wheelchair or are confined to their beds for prolonged periods of time. As a result, such patients put an incredible amount of constant pressure or shear force on the same location of the body. When the same location on the body withstands constant pressure or shear force, a pressure ulcer can develop in that location. A pressure ulcer is an injury to the skin and the underlying tissues. Pressure ulcers typically develop on skin that covers bony areas of the body, such as the heel, ankles, hips, or buttocks.
Pressure ulcers are increasing in frequency among a diverse population. In particular, at risk are elderly patients with neurological abnormalities, patients with diabetes mellitus, and patients with dementia or other mental illnesses. Many of these patients are unable to move around and adjust themselves properly, so a family member, a nurse or other medical attendant is required to assist them at predetermined intervals. In some cases, the family member, the nurse or medical attendant is not available to assist with adjusting the patient's body position. Without assistance, the patient will remain in the same position increasing the likelihood of developing pressure ulcers.
There are four stages of pressure ulcers, depending on the depth of the wound and the level of tissue involvement. Stage 1 involves erythema and edema of the skin. Stage 2 involves a partial loss of skin thickness, which may include a loss of the epidermis, dermis, or both. The lesion is superficial and appears as an abrasion, blister, or shallow ulcer. Stage 3 involves a complete loss of skin thickness and includes damage or necrosis of subcutaneous tissue that may extend down to the underlying fascia. The pressure ulcer will appear as a deep crater with or without damage to the adjacent tissues. Stage 4 is the worst stage, whereby the pressure ulcer exposes the underlying tissue including tendons, bones, and ligaments.
The morbidity and mortality associated with pressure ulcers is well known. Medicare and other health insurance providers often recognize pressure ulcers as a complication of hospitalization. As such, the health insurance providers are monitoring pressure ulcer rates more closely and are increasingly less likely to reimburse the costs of treating pressure ulcers that occur in a hospital setting. Additionally, long-term care facilities and nursing homes have been scrutinized for many years at both the state and federal level, with attention to complications such as pressure ulcers.
Treatment of pressure ulcers typically includes surgical debridement, treatment with antibiotics, negative pressure dressings, and modification of the underlying skin deficit. In order for the treatment to be successful, it is paramount that the pressure and shear force on the pressure ulcer be minimized. This is typically done by repositioning the patient, using a “shifting” mattress, or by use of barrier dressings.
These are also the same means used to prevent the pressure ulcer from developing. Thus, if these means weren't sufficient to prevent a pressure ulcer, they may prove ineffective at treating the pressure ulcer. As part of the treatment for pressure ulcers, it is imperative that the pressure ulcer is not subjected to pressure or shearing forces. Because of the typical location of the pressure ulcer (pelvic area, lower area, tail bone, hip), it is often extremely difficult to prevent any pressure or shear forces from being placed on the pressure ulcer. This is especially true given that it may take several months to heal a pressure ulcer.
To date, there has not been any treatment that effectively protects the pressure ulcer from pressure and shear effects.